The American College of Radiology (ACR) recently released clinical guidance regarding pulmonary embolism reporting, specifically the Pulmonary Embolism Reporting and Data System (PE-RADS) which creates a standard lexicon of terms and descriptions used in diagnosing acute pulmonary embolism at CT and MR angiography. The system provides a framework that will assist in guiding treatment based on right heart imaging features and clot location.

The goal of PE-RADS is enabling clear communication between coordinating care teams attending to patients with pulmonary embolism. The ACR notes that PE-RADS is complementary to existing guidelines from medical societies including the American Heart Association (AHA), American College of Cardiology, the American College of Chest Physicians (CHEST), and others.

The guidance illustrates an anatomic depiction (figure 2A) of pulmonary arterial vasculature for ordinal scoring of thrombus for PE-RADS. It divides the locations into five categories based on pulmonary arterial location of the most proximal embolus (PE-RADS [0-4]):

  • PE-RADS 0: None
  • PE-RADS 1: Subsegmental
  • PE-RADS 2: Segmental
  • PE-RADS 3: Lobar (including interlobar)
  • PE-RADS 4: Main, Right and Left
PE-RADS Assessment Categories

Additionally, assessment categories are provided in the guidance that specify scoring, findings, and management and referral considerations. The assessment is outlined below. For the complete look at the assessment, view Table 5 in the full-text version of the ACR guidance. 

  • PE-RADS 0: No acute PE present; Acute PE is not the cause of the patient’s symptoms. Consider alternative diagnosis.
  • PE-RADS 1: Acute PE is present; Anticoagulation and bleeding risk. Assessment of clinical symptoms and VTE risk factors; Consider lower extremity venous imaging in isolated subsegmental PE to inform anticoagulation management vs surveillance.
  • PE-RADS 2: Acute PE is present; Anticoagulation and bleeding risk. Assessment of clinical symptoms and VTE risk factors.
  • PE-RADS 3: Acute PE is present; Anticoagulation and bleeding risk. PE risk stratification.
  • PE-RADS 4: Acute PE is present; Anticoagulation and bleeding risk. PE risk stratification.

Right ventricle enlarged (RV+), thrombus positive (T+), non-diagnostic (N), and limited (L)  statuses are also provided in Table 5, similarly outlining scoring, findings, and management and referral considerations. 

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